For anyone who watched the opening ceremony of the 2012 Summer Olympics in London, the pride Britain takes in its National Health Service (NHS) is clear. Far from the apathy that most Americans feel toward government-provided services, the NHS has been a popular feature of British life since it emerged during the late 1940s as part of the Labour Party’s postwar government. That makes the debate about how to prepare the system for an expected rise in demand at a time of austerity politically sensitive.
The NHS is a public health provider that offers treatment “free at the point of use” and gets the majority of its operating income from taxes. But like health-care providers across the developed world, the organization is coping with strain as it balances Britain’s aging population against the country’s generally lower economic activity and rising health-care costs.
The Conservative Party-led coalition government has tried to improve the situation by privatizing an array of NHS services, creating a hybrid model in which most of the services that patients interact with are government-provided but many of the auxiliary services no longer are.
This has generally not been received well. The breakdowns in service provision directly attributable to this health-care delivery method have been documented in a number of recent studies. Polls show voters trust the opposition Labour Party more to improve the NHS than they do the Conservatives. This is not in itself new but alarming to Conservative Party strategists nonetheless. In response, George Osborne, the chancellor of the exchequer, announced a £2 billion funding increase for the NHS last week.
The funding increase is a functional necessity as well as a smart political move. It came after several weeks of poor publicity for the Conservatives on the issue.
Last month, Jeremy Hunt, the health secretary, advised Britons to visit pharmacists for minor health problems when they are facing long delays in seeing a general practitioner. He said so after figures showed the number of patients visiting emergency services had increased by 3,000 per day compared to under the last government. Most are not actually in need of hospital care but simply unable to see a general practitioner as quickly as they would like.
This news came on the heels of Prime Minister David Cameron’s admission that the NHS was “under pressure” and failing to meet its performance goals.
All of this has turned the NHS into one of the biggest political footballs of the upcoming parliamentary elections — and one that concerns people across the ideological spectrum.
With this in mind, the Conservative Party had already pledged to make no cuts to government health-care spending or pensions. However, Osborne does want to make deep spending cuts elsewhere to achieve a balanced budget before the end of the next parliament. It will be difficult to keep both promises, especially without raising taxes.
Indeed, the Conservatives want to reduce taxes by more than £7 billion through the end of the decade. According to the Institute for Fiscal Studies in London, that means “spending on services such as police, transport, local government and environment” would have to be reduced by a third or more.
The fiscal situation gets worse if the NHS isn’t only exempt from spending reductions but would actually need more money. That seems likely. Its current operating budget appears insufficient already and demand for health services is projected to increase dramatically as the population ages.
The United Kingdom as a whole fares poorly compared to other Western countries in noncommunicable disease indicators, such as obesity and heart disease, factors that will also strain the organization’s operations.
With a looming election, tough choices will have to be made between service provision, efficiency and tax rates across the board. It is not necessarily the case that the incumbent government’s prioritization is correct. While voters seem focused on health care at the moment, increases in crime related to police budget reductions, for example, could swiftly change their perceptions of where spending needs to be allocated. In the short term, the Conservative Party has no choice but to emphasize consistent health-care service provision. However, if they are elected again, the only choice moving forward without tax increases will be further privatization and more public-private partnerships.